Provider Demographics
NPI:1417762030
Name:DEVRIES, STEPHEN J
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:DEVRIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:416 W 15TH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3672
Mailing Address - Country:US
Mailing Address - Phone:405-562-6072
Mailing Address - Fax:
Practice Address - Street 1:416 W 15TH ST STE 600
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3672
Practice Address - Country:US
Practice Address - Phone:405-562-6072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician